Director, Provider Contracting - San Diego, CA market (Hybrid)

WORK LOCATION: HYBRID position aligned to the San Diego, CA market.

The Director, Provider Contracting serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager or VP of Contracting.

This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.

DUTIES AND RESPONSIBILITIES


* Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).


* May lead a team with direct reports.


* Point person for complex projects related to contracting strategy in the market.


* Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.


* Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management.

Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.


* Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.


* Contributes to the development of alternative network initiatives.

Supports and provides direction to develop network analytics required for the network solution.


* Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.


* Creates and manages initiatives that improve total medical cost and quality.


* Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.


* Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.


* Creates "HCP" agreements that meet internal operational standards and external provider expectations.

Ensures the accurate implementation, and administration through matrix partners.


* Leads in resolving elevated and complex provider service complaints.

Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.


* Manages key provider relationships and is accountable for critical interface with providers and business staff.


* Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.


* Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.

POSITION REQUIREMENTS


* Should possess a bachelor degree; preferably in the areas of Finance, Economics, Healthcare or Business related.

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